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Ахмедов Саидазиз Пулатович,
Юнусходжаева Мадина Камалитдиновна
Тошкент Давлат Стоматология Институти
Ризаев Жасур Алимджанович,
Самарканд Давлат Тиббиет Институти
СУРУНКАЛИ ЛЕЙКОЗЛАРДА СТОМАТОЛОГИК СТАТУС ХУСУСИЯТЛАРИ
http://dx.doi.org/10.26739/
2181-0966-2021-1-16
АННОТАЦИЯ
Сурункали лейкоз билан беморларнинг стоматологик статуси оғиз бўшлиғи гигиена ҳолати паст даражада бўлиши
билан тавсифланади; юқори КПУз индексли пародонт тўқималари ва оғиз шиллиқ қавати касалликларининг сезиларли
тарқалганлиги; тиш тўқималари ва тиш қаторининг қаттиқ нуқсонларни бартараф этиш учун ортопедик даволашга учун
беморларнинг юқори эҳтиёжи.
Калит сўзлар
: лейкоз, сурункали шакли, стоматологик статус
Ахмедов Саидазиз Пулатович
Юнусходжаева Мадина Камалитдиновна
Ташкентский Государственный Стоматологический институт
Ризаев Жасур Алимджанович
Самаркандский Государственный Медицинский Университет
ХАРАКТЕРИСТИКА СТОМАТОЛОГИЧЕСКОГО СТАТУСА ПРИ ХРОНИЧЕСКИХ ЛЕЙКОЗАХ
АННОТАЦИЯ
Стоматологический статус пациентов с хроническими лейкозами характеризуется низким уровнем гигиены полости
рта; значительной распространенностью заболеваний тканей пародонта и слизистой оболочки рта с высоким индексом
КПУз; высокой нуждаемостью пациентов в ортопедическом лечении по поводу устранения дефектов твердых тканей зубов
и зубных рядов.
Ключевые слова
: лейкоз, хроническая форма, стоматологический статус
Saidaziz P. Akhmedov
Madina K. Yunuskhojaeva
Tashkent State Dental Institute
Jasur A. Rizaev
Samarkand State Medical University
CHARACTERISTICS OF DENTAL STATUS IN CHRONIC LEUKEMIA
ANNOTATION
The dental status of patients with chronic leukemia is characterized by low level of oral hygiene; significant prevalence of
periodontal and oral mucosa diseases with high index of carious, filled and extracted teeth; high need of patients for orthopedic
treatment to eliminate dental hard tissue and dental row defects.
Keywords:
leukemia, chronic form, dental status
Leukemia is a malignant disease of blood cells
characterized by unregulated proliferation of leukocytes in bone
marrow, peripheral blood and in extramedullary areas [1, 6].
It is important to note that leukemias are divided into
acute and chronic primarily by morphological features of tumor
cells. Thus, acute leukemia never transforms into chronic one,
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and chronic into acute one. At the same time, in the course of
chronic leukemia, blast crises occur, in which the blood picture
becomes similar to that of acute leukemia [4]. Dentists often
encounter ulcerative-necrotic and hemorrhagic manifestations in
such patients, because most complications of the leukemia
process are reflected in the oral mucosa [2, 3, 5].
Currently, the pathogenesis of chronic leukemia is well
enough studied. However, in combination with manifestations in
the oral cavity and from the point of view of the orthopedic
dentist, the problem requires further investigation. Conducting
preventive and therapeutic dental care in patients with chronic
leukemia is a significant challenge, since most manipulations
performed in the oral cavity are to some extent traumatic. All
activities of invasive nature in the oral cavity in patients with the
pathology in question should be performed in the conditions of
hospital with simultaneous hemostatic therapy and only in the
remission period.
Objective
: to study the dental status in patients with
chronic leukemia.
Materials and methods of the study
A total of 32 patients aged from 60 to 74 years were
examined. The study group included 16 patients with confirmed
diagnosis of chronic lympholeukemia (the 1st subgroup – 8 men
and the 2nd subgroup – 8 women). The comparison group
consisted of 16 patients who underwent professional medical
examination with a positive conclusion of workability and
"healthy" status (the 1st subgroup – 8 men and the 2nd subgroup
– 8 women).
We determined the following indices: Green-Vermillion hygiene
index (G-V), gingival recession index, Muhllemann-Cowell
index; the number of carious, filled and extracted teeth, the
presence of oral mucosa diseases, the number of dental defects,
the presence and quality of dentures, objective examination of
the oral cavity and skin in the orofacial area [1].
Statistical data processing was performed using Excel 2017
application software package, including traditional methods of
variance statistics. Two independent groups were compared
using the Mann-Whitney test. Such differences with p≤0.05 were
considered statistically significant.
Results of the study and their discussion
The oral mucosa of patients with chronic leukemia is, as a rule,
somewhat hyperemic, and areas with hemorrhagic changes are
identified (Figures 1 and 2).
Fig. 1. Hemorrhages on the mucosa of the lip
Fig. 2. Hemorrhages on the mucosa of the tongue
Green-Vermillion hygiene index values in male patients with
chronic lympholeukemia (1 main group subgroup) averaged
2,85±1,3; in female patients with the disease (2 main group
subgroup) 2,32±0,68 (р=0,0119). In the comparison group,
1,68±0,62 (p=0.0009) in men (1 subgroup of the comparison
group); 1,13±0,39 (p=0.020) in women (2 subgroup of the
comparison group).
The index values of the number of decayed, filled, and extracted
teeth in the patients of the main group 1 subgroup averaged -
23.75 ± 3.37; in the patients of the main group 2 subgroup –
22,87±3,27. In the comparison group – 20,876±3,39 in men;
19,99±3,41 in women.
The Muhllemann-Cowell hygiene index values for patients in the
1st subgroup of the main group averaged 2,25±0,7; for patients
in the 2nd subgroup of the main group, 2,12±0,83. In the
comparison group, 1,25±0,88 in men; 0,5±0,53 in women. In the
patients of the main group 1 and 2 subgroups severe degree of
inflammation prevails.
Gingival margin recession index values in patients in the 1st
subgroup of the main group averaged 36,37±6,13; in patients in
the 2nd subgroup of the main group – 29,12±6,35. In the
comparison group – 15,62±4,59 in men, 10,62±3,42 in women.
The study determined the presence of lesion elements according
to the classification of S.N. Bhaskar (1997), in which the
pathology of the oral mucosa is systematized through the leading
clinical symptom: "white" (W) lesions, vesicular lesions,
erosive-ulcerous lesions, "pigmented" lesions. All patients of the
main group have erosive-ulcerous (E), "white" (W) and vesicular
(V) lesions: in patients of the 1st subgroup of the main group the
following lesions were revealed: erosive-ulcerous – 62%,
"white" – 25%, vesicular – 12,5%.
Fig. 3. Element of the lesion on the mucosa of the patient's
tongue
Patients of the main group 2 subgroup revealed: erosive lesions
– 50%, "white" lesions – 25%, vesicular lesions – 25%. No
chronic diseases of the oral mucosa were detected in the patients
of the comparison group.
It was determined that the majority of patients of the main group
had unsatisfactory condition of dentures and needed orthopedic
treatment – 63,5%.
Data of objective examination. Mucosa of the oral cavity has
pink color (more intensive in the cheeks, lips, transitional folds
and less intensive - on gums). The mucous membranes have
lesion elements (Fig. 3); the facial skin has physiological
coloring, there are bruises and single petechiae.
Conclusions.
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1.
Dental status of patients with chronic leukemia is
characterized by a low level of oral hygiene; significant
prevalence of periodontal and oral mucosa diseases with a high
index of the number of carious, filled and extracted teeth; high
need of patients for orthopedic treatment to eliminate dental hard
tissue and dental row defects.
2.
Reliable differences of parameters of hygiene index
Green-Vermillion (G-B), Muhllemann-Cowell index, gingival
margin recession index are revealed in comparison group
patients.
3.
The results of this study indicate that there is a need to
develop a set of measures aimed at improving the level of dental
health of patients with chronic leukemia.
4. Dynamic monitoring of this category of patients by
dentists with regular control of periodontal tissues and timely
splinting of movable teeth with the use of rational orthopedic
structures is mandatory.
5.
Before carrying out any dental manipulations,
it is mandatory to examine the hematopoietic system and carry
out appropriate medication preparation to prevent bleeding.
There is also a need to protect the oral mucosa and marginal
periodontal tissues from traumatic effects at the stages of
therapeutic and prosthetic treatment.
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Vinogradova T.F. Guidelines for pediatric dentistry. - Moscow: Medicine, 1976. – 255 p.
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rta.info/yaz2_sm.phpid=11 (date of reference: 06.03.2017).
3.
Moseichuk O.A. Prevention of basic dental diseases in children with acute lymphoblastic leukemia: Ph. - Ekaterinburg, 2006.
– 18 p.
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Basics of clinical hematology: textbook / S.A. Volkova, N.N. Borovkov. - N. Novgorod: Izd. of Nizhny Novgorod State
Medical Academy, 2013. – 400 p.
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